Davenport Andrew
UCL Center for Nephrology, Royal Free & University College Medical School, London, UK.
Hemodial Int. 2008 Jul;12(3):307-12. doi: 10.1111/j.1542-4758.2008.00271.x.
The incidence of acute brain injury in chronic hemodialysis patients is increasing, as the dialysis population is becoming increasingly older, often hypertensive, at risk of ischemic and/or hemorrhagic stroke, and subdural hemorrhage. Standard intermittent hemodialysis treatments typically lead to an increase in cerebral swelling, which can exacerbate underlying cerebral damage. In critically ill patients, continuous modes of renal replacement therapy may be required, but depending upon the clinical condition, simple modifications to standard intermittent therapies may suffice, and allow effective delivery of renal replacement therapy, but ensure that patient outcomes both in terms of mortality and residual functional brain damage is no different between those with normal renal function and those on the chronic dialysis program.
慢性血液透析患者急性脑损伤的发生率正在上升，因为透析人群的年龄越来越大，往往患有高血压，有缺血性和/或出血性中风以及硬膜下出血的风险。标准的间歇性血液透析治疗通常会导致脑肿胀加剧，这可能会加重潜在的脑损伤。在危重症患者中，可能需要采用连续性肾脏替代治疗模式，但根据临床情况，对标准间歇性治疗进行简单调整可能就足够了，这样既能有效实施肾脏替代治疗，又能确保肾功能正常的患者与接受慢性透析治疗的患者在死亡率和残余功能性脑损伤方面的患者预后没有差异。
